OPHTE# Al 's-' 4C433 Harnett County Department of Public Health
PERMIT # ,?r/ql -57 Operation Flmit 21 7 3 8
New Installation Septic Tank 2( Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 106 r;, 014) 46
Name: (owner) ro` J" ' ~~v SUBDIVISION LOT #
System Installer: x Registration #
Basement with plumbing: ❑ Garage lumber of Bedrooms
Type of Water Supply: ❑ Community V public El Well Distance from well feet
System Type: Z5% s ~O 9-Z 4-4-7 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner mu contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew je disposal system on the above captioned property.
Type of system: ❑ Conventional 10 Other l"O°lvlll~~3 e 600 Se tic Tank: bb_ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ~0 feet ditches ~ feet ditches inches
French Drain Reauired: Linear feet
Authorized State A¢ _ _ Date - _